First Pacemaker

Me too

by AgentX86 - 2018-08-18 00:37:07

I had a similar situation (I think it's all in my bio).  I had a choice of going down that road (ever more sotalol) but it's really not a very long road.  Antiarrhythmics tend to have a limited usefulness.  I chose ablations because I really didn't want a pacemaker and once it was obvious that there wasn't a choice, I didn't want to have to be on antiarrhythmic drugs for life (or when they all stopped working).  They're *all* bad news.  I chose an AV ablation and VV pacemaker, once they detected the long pauses.

Risk is risk

by Theknotguy - 2018-08-18 07:58:02

Don't  understand your comment, "Don't need blood thinner as stroke risk factors show zero." Especially since you're having afib sessions.  

Any time you have afib you are in danger of a temporary heart pause, the blood pools in the heart, you get a clot.  Then when the heart starts to beat again the clot can be pumped out with danger of heart attack, stroke, and the like.  Risk is risk.  So once you start afib you have the problem of a possible clot and you need blood thinners to prevent or lessen the risk of a clot.  I'm very surprised you aren't on blood thinners now.  Am I missing something in your comments?

I will tell you from past painful experience having a blood clot in the heart is no fun.  My heart started into afib, did the dipsy-doodle, a clot formed, and bang! I hit the floor.  It happens that fast.  Then you spend a month on heavy blood thinners while they monitor you to see if the clot dissolved.  Even with being on blood thinners there still is a danger until the clot dissolves that a weak clot can be pumped out and you still can get a stroke or heart attack.  Everyone walks around on pins and needles until then.  Oh, and I forgot to mention the clot prevents good blood flow so you walk around gasping for air.  You can stand up and walk for about 20 steps then you have to lean up against the wall until you get enough air to keep on walking.  Your heart doesn't like the fact there is a clot so it keeps going into afib and all sorts of weird beating rhythms until the clot dissolves.  You pretty much can't do anything until the clot dissolves.  Blood clots in the heart are no fun!

As for afib, there is rhythm control and there is rate control.  I'm on rate control because of afib.  That's where they give you heart drugs to slow the heart and lessen the sessions of afib.  Then use the pacemaker to bring the heart rate up to a "normal" setting.  Since you have afib and your heart rate dropped to 40 I'm guessing they are starting you on rate control too. 

Ablation is great if it works.  For some people it doesn't or it works for a few years then returns.  Not something you'd like to look forward to.  There are now many drugs like Sotalol that slow the heart.  Your doctor may continue to use it beccause it's been successful so far.  However if it's starting to make you feel tired there are other drug options.  You will probably want to discuss your options with your EP/Cardiologist.  

One other question.  Did they give you one of the pacemaker brands that can be programmed to control afib?  You didn't say.  

Otherwise, welcome to the club you didn't want to join.  I hope your transition to life with a pacemaker goes smoothly.  

Blood thinners

by AgentX86 - 2018-08-18 11:37:38

I agree with Knot (forgot to mention it in my previous post).  Anytime you're in AF, you should be on anticoagulants.  Period.  Blood clots are nothing to fool with and there is no such thing as a zero risk. You my have a zero score on the CHADS2 stroke risk asessment but that doesn't mean a zero risk.  Your risk of stroke is still five times that of the general population.  At 57, you don't want a stroke.

I dispised being on warfarin (rat poison) but since my cardiologist put me on Eliquis, it's all been good.  I do have a chance of my EP taking me off anticoagulants completely but only because I had my left atrial appendage closed when I had the CABG surgery in '14.  He said that we'd talk about it next appointment.  Frankly, being on Eliquis, I'm not going to push the issue.

Blood thinner

by Magpie58 - 2018-08-18 22:22:01

Will discuss at length with cardiologist, the blood thinner issue. I have an appointment in 10 days, and I will ask for the reasons again(They told me, but I had a bit going through my head at the time). I understand that I will always have a risk, and it was the CHADS I was referring to. I will just have to get clarity.

Sotalol is to control heart rate, and pacemaker is to prevent the pauses, by not letting it go below 60, without firing a pulse.

They believe, if they control both these, with my condition, as it is, they should be able to control A-F.

It's all new to me, and I obviously will have questions.

Being on here(not something I have been big on, as I am a very private person), will help me immensely. Just reading all the different cases and trying to find similarities.

Thanks all, for your input, and taking time to respond, I appreciate it very much.

One thing is for sure, and that is, it doesn't matter how you prepare yourself, that diagnosis of heart disease, in any form, is hard to take.

Good health to all.

Blood thinners

by AgentX86 - 2018-08-19 00:25:42

Hi Mags.  No reason to be shy. We're all in the same boat, one which none volunteered for.  Well, other than the best of bad options. 

I understand the CHADS argument, however that doesn't apply when you're in AFib.  If you're proximal and symptomatic, it may make sense to only take anticoagulants when you're actually in AFib. My cardiologist used the CHADS score to determine whether to take me off anticoagulants between AFib bouts (after cardioversions and ablations) but while I was actually in AFib there was no question.

Sotalol isn't really a rate control drug, although it does depress the heart rate.  It is an antiarrhythmic and a powerful one.  None of this class of drugs is benign.  Sotall is what caused my bradycardia and pauses.  Rate control drugs would include beta blockers (e.g. Metoprolol) and Calcium Channel Blockers (e.g. Diltiazem).

Heart disease isn't something you can prepare for.  It just is. One has to deal with it the best one can. You can't run away from it.

PM Type

by Magpie58 - 2018-08-19 22:23:16

It is a Medtronics Azure S DR MRI Surescan, which I believe is a dual chamber, rate adaptive version, and from my limited research, can sense A-F, and assist accordingly.

If that is the case, it may explain the lack of blood thinner, being that I would be at risk of stroke when in A-F, but if A-F is controlled, lessens or eliminates the risk. Not sure, and will certainly be asking these questions on return to cariologist.

I was prescribed Eliquis(before they realised I needed pacemaker), but then told not to use yet.

With regard to heart rate dropping to 40, that is my actual resting eart rate, due to fitness level and lots of long distance running over the years, like training runs of 3-4hrs.

The concern was that, by controlling upper level of heart rate, to bring it back to a reasonable level, there was a risk that it would also bring down my already low resting rate, hence the pacemaker being set to 60 at bottom end.

Cardiologist understands that I want to return to running, but first, we must make sure I will be safe.

Have been told that if A-F returns, may need ablation later.

It's all new at the moment, a bit daunting, and I am sure there will be plenty more questions going forward.

PM Type

by AgentX86 - 2018-08-19 22:53:04

There are so many models that it's impossible to keep up with them.  You mention that it has AF mitigation capability.  It's my understanding that this really doesn't work well and certainly isn't reliable.  My EP is quite down on this technology, though now it's not clear to me that he meant that it had no chance of helping me or that it wasn't useful at all.  I've heard from others that it's certainly problematic and from some who have it that it works, sometimes.

A pacemaker cannot reduce the maximum heart rate.  As someone in this group said a while back, it's only an accelerator.  There is no brake pedal. The reason for the pacemaker is to keep the resting heart rate up, then they can pump you full of beta blockers or calcium channel blockers to cap the maximum heart rate.

Stroke is pretty serious and I wouldn't fool around with it.  Your EP is certainly the one to talk to about this. Make sure you understand your situation perfectly. If you have an SO, perhaps you want to bring him/her along to make sure it's well understood. Do some research beforehand.  I'm certainly not saying that your EP is wrong, just that it's critical that you (both) get this right.

I'm a fan of Eliquis.  I didn't like Warfarin at all and was really PO'd when I ended up with atypical AFL after the Maze procedure (huge intervention to get rid of AF).  Switching to Eliquis made it a whole lot more palatable.  Yes, it's understandable that they didn't want you on it for surgery.  They just had me skip it the night before, if I remember correctly. it has a very low half-life.

I understand that low heart rates are normal for chronic health nuts.  ;-)  However, 40 is unusually low.  50 is more usual.  My guess is that you've had bradycardia for some time.  "Excessive" exercise damages the heart's electrical system.  AF and bradycardia are quite common among distance runners.

Ablations are a piece of cake but, unfortunately it often takes a few passes to get right, if then.  Do yourself a favor and go only to the best ablation EP possible.  He should be doing at least a hundred procedures a year.  You're only going to get a few chances of getting it right.  Don't waste them on a hack. It's not an invasive procedure but only an artist can get it right.  There are few artists in this field.

PM type

by Magpie58 - 2018-08-20 00:38:43

Thanks AgentX86.

So much info out there, just need to sort through and discuss with medicos.